Is medication really necessary?

Thanks so much. I start Tymlos on Monday and I am so scared. Now even more so.

sgmlt2,
I waited until I was osteoporotic, even though it is said that more women fracture in osteopenia.
Factors to weigh are age, as in hormone status; activity: type and level; and balance issues.
Did you get a frax risk and/or TBS reading with the imaging.
Osteopenia with a T score of -2.4 would suggest a close look at the medications.
Most of us have osteoporosis because of hormone loss. If you were beginning peak years of loss 50 to 62 you'd be in advancing danger.
I'm not fond of the way bisphosphonates work, and they are often the drugs we are offered in osteopenia.
If you fracture because of the decision to avoid the medication, the pain and loss of function will be difficult to reconcile.
It is easier to prevent loss than to regain bone.
If you decide to take medication, you still have do all the other things that are considered alternative.

You will get a lot of varying opinions on this topic.
I’ll give you my personal opinion based on my experience.
In 2018 I was diagnosed with osteoporosis. I was 58 years old.
After 5 different osteoporosis medications, and debilitating side effects, and 6 pelvic fractures, I decided to start hormone replacement therapy at 65 years old, 15 years past menopause. For me the benefits for my bones outweighs the risks of starting HRT at my age.
I will tell you that while exercise, healthy diet, and certain supplements are good for you and your bones overall, it will not be enough to grow bone. It just doesn’t work that way for the majority of people.
Do all the healthy things because it increases your healthspan, but you will probably need to address the bone loss eventually.
Best of luck.

It is disappointing that we have to find out the sequence that OP meds should be used for ourselves rather than our doctors knowing.

Best of luck to you on your April endo visit. I hope you find a treatment regime that works well for you.

sgtmlt2, better to have an endocrinologist. But even then
At-2.5 I'm comfortable recommending Forteo or Tymlos and suggesting that you not take Reclast as the first medication. You may want to moderate your activities. Those of us who climb ladders, ride horses, climb mountains an ski are more likely to fracture because we sometimes fall.
Stay with Mayo Connect because there is wonderful information from people who have a broad range of experience. You really do have to question your doctors and all of us with our opinions and make the decision that sounds right to you.
Personally, I don't think that you can regain steady bone without the medications. Luckily there are others who
have different opinions and you can quiz us at every turn.
It's pretty interesting.

Understanding that everyone’s situation is unique, I wanted to share what I consider a hopeful story. I was diagnosed with osteoporosis in 2021 with a single score marginally beyond the standard -2.5. In 2024, three scores were again, marginally out of normal range. Like so many of us, I faced the challenging decision of going on the OP medications or seeking another option. I was determined not to take the meds because of the possible side effects, some more serious than others. I consulted with a functional medicine doctor and we formulated a plan that I was committed to trying for a period of one year, to be followed by another DEXA scan including a trabecular bone score. It included some dietary changes, physical therapy exercises specifically targeting osteoporosis every other day (at home), a weekly chair/fusion yoga class, a different calcium supplement that the doctor felt is better absorbed, and walking three miles a day at a good pace. I just received my test results today and there was no statistically significant change in my bone density. A couple of scores improved slightly and two scores worsened by just 1/10th. My trabecular bone score, which concerns the micro architecture of the bones, was in the normal range. I was thrilled. The personalized program was successful. The effort and changes were well worth it. I will continue to follow the plan for another year at which time, I will retest and reevaluate my situation. Good luck to everyone out there trying to deal with osteoporosis.

Good for you! What was the calcium that your doctor felt was better absorbed?

Thanks so much. I start Tymlos on Monday and I am so scared. Now even more so.